Flashcards in Pericardial Diseases (complete) Deck (23)
What are the layers of the pericardium?
Outside to inside:
- Fibrous layer
- Parietal pericardium
- Pericardial cavity
- Visceral pericardium
What are the common causes of acute pericarditis?
- Viral illness
- CT or autoimmune diseases
- Metastatic tumors
What are the common presentations of acute pericarditis?
- Sudden onset chest pain (SEVERE) => sharp
- Chest varies w/ position and breathing => this is NOT the case w/ MI
MI pain is also pressurized than sharp
How do you diagnose acute pericarditis?
- Chest pain varies w/ position, breathing
- Pericardial rub on cardiac exam (comes and goes)
- EKG => diffuse ST elevation
- ECHO => pericardial fluid
There is a response to anti-inflammatory agents (NSAIDs are preferred, also aspirin and *colchicine*)
Where do you see diffuse ST elevation on an EKG?
It's everywhere! at every lead!
- NOT an MI => you'd be dead by now
- think pericarditis
What are the common causes of pericardial effusion?
- Viral/acute idiopathic pericarditis
- Metastatic malignancy
- Autoimmune disease
Now there's fluid accumulation
How is pericardial effusion best diagnosed?
Describe small pericardial effusions
- W/o high intrapericardial pressure may be asymptomatic
- happens w/ acute trauma (gun shots, stabs)
Describe large pericardial effusions
- Has high intrapericardial pressures
- Causes cardiac tamponade
What is cardiac tamponade?
- Heart is unable to fill appropriately
- Myocardial compression impairs diastolic filling
- Causes by rapidly accumulates moderate sized or large effusions
Describe the clinical presentation of pericardial effusion with tamponade
- Decreased RV diastolic filling during inspiration
- Distended neck veins
- Inspiratory decrease in arterial pressure (15-20 mm drop in systolic pressure) => paradoxical pulse
Why does the BP drop with pericardial tamponade?
- Free wall of RV is unable to expand with each inspiration (b/c of effusion)
- In order to accomodate for increase in blood flow => it pushes septum => LV has a decreased SV
What medication do you not want to give to patients with pericardial tamponade?
-In fact you may want to give them fluid
- A stab wound will already decrease the BP b/c of fluid loss => not enough blood being pumped
- You want to increase BP to ^ blood to the rest of the body
- Diuretics would cause the pt to go into shock
What findings do you expect to see and not see in a chest Xray?
- Enlarged heart
- Non-congested lungs (you would see this only in MI w/ lungs vessels accommodating the heart)
Describe the findings in an ECHO of a pt w/ pericardial tamponade
- Collapse of RA and RV at end-diastole
- Dilation of IVC (does not collapse during inspiration)
What do you expect to see on an EKG of a pt/ with pericardial tamponade?
- Low QRS voltage
- Also sinus tachycardia
- Electrical alternans w/ sinus tachy (every other beat the QRS voltage decreases)
Describe constrictive pericarditis
- Scarring or loss of elasticity of pericardium
- Impaired diastolic filling w/ NORMAL systolic function
What are the causes of constructive pericarditis?
- After cardiac surgery
- Infectious (TB is common)
Describe the clinical presentation of a pt w/ constructive pericarditis
- Elevated JV pressure
- Tachy (very little filling of heart chambers => decreased SV => ^ HR to maintain CO)
- Often w/ hepatomegaly, edema, ascites
Looks like they have chronic liver disease
How do you diagnose constrictive pericarditis?
- Transthoracic echo may see pericardial thickening (maybe calcified)
- MRI or CT can see pericardial thickening
- Cardiac cath shows an early dip and plateau pattern (*square root sign*) during diastole
- Cardiac cath shows equalization of diastolic pressures in RV and LV
Describe the "clinical points" of constrictive pericarditis
- Chronic disease => takes lots of time to develop
- Cardiac silhouette normal sized but encased by thickened pericardium
- Lungs not congested
- Mistaken for liver disease b/c of prolonged high venous pressure => hepatic enlargement and ascites
What is the treatment of constrictive pericarditis?
Surgical stripping of pericardium